The public health system does not manage to close the wounds left by the crisis. The amount of money that is invested it can be deceptive in it. The levels of investment before the crisis have already recovered (more than 73,000 million per year, from 65,749 in 2013, when it hit bottom), but, as with the large macroeconomic variables, this recovery has not yet reached the day a day of the system. Indicators such as the waiting list, the number of operating beds, hospital admissions for mental health problems of the population and the perception of users do not reach the levels before the crisis.
The data show that health in 2008 accounted for 6.1% of GDP, which in 2010 rose to 6.7% and since then has dropped to 6.26% in 2017. Interestingly, per capita spending has changed less in the years of the crisis, during which it has oscillated between 1,410 and 1,577 euros on average, than between communities in the same year. In 2018 Catalonia budgeted a little less than 1,200 euros; the Basque Country, almost 1,700.
And this to speak of measurable factors, within a system little prone to give data. The recent resignation of 22 heads of service of Vigo in protest against public policies, protests by the cut of the schedules in primary in Madrid and the mobilization of nursing assistants are symptoms of the seams tightening the system. As Javier Martín, Head of Health of the CSIF union, says, "in some aspects it has been possible to return to the situation of 2008, but in these 10 years the population has aged, the portfolio of services has been extended, and the situation of So it does not mean to go back to a good time. Even then the system did not give more than itself ". That's why the white tides, although focused on stopping the privatization of health, they immediately caught up with professionals and patients.
Millions of euros
In addition, both Martín and Marciano Sánchez-Bayle, of the Federation of Associations for the Defense of Public Health, look with suspicion at the figures of health investment of the last two years, which they consider pushed up by the numerous electoral processes.
Personal. With the personnel, something similar happens with the spending: the total figure is close to that of before the cuts (in 2012 there were 508,000 people, according to the Ministry of Finance), went down to less than 479,000 and they are already over 500,000 again. But as the CSIF spokesperson warns there has been an aging workforce, and Temporality is around 30%. "Many people have contracts for weeks or days," criticizes Martín. This is a chapter in which, clearly, returning to the absolute figures of before the crisis represents a decade of missed opportunities. In the years of the crisis, mobility has been reduced and public calls for employment and professional careers have been delayed or eliminated (recognition of merits with their corresponding economic repercussions).
PERSONNEL IN HEALTH INSTITUTIONS
Waiting lists. With the warning that there have been a couple of changes in the methodology of the series that advise talking more about trends than about specific data, the waiting lists show a deterioration from 2008 to 2016, with a slight improvement in the last year (the count of the Ministry of Health ends in June 2018). This line is common, it does not matter if it refers to the surgical wait or for consultations.
LIST OF SURGICAL WAITING
Days of average delay
Hospital beds. With the same number of publicly owned hospitals in the network (about 780), operating beds have increased from 115,000 in 2010 to 110,000 since 2013 (109,913 in 2016). The unions clearly relate this fact to the increase in waiting lists, and attribute this to cuts in personnel. Laura Vallejo, president of the Health Economics Association, warns, however, that both in this indicator and in those that refer, for example, to spending per person, one must be prudent, since there may be an increase component of efficacy, for example, with processes that require less hospitalization time.
BEDS IN OPERATION
Mortality. The death rate per 100,000 inhabitants is also on the rise, according to data from the National Institute of Statistics (INE), but Vallejo also calls for caution, since the aging of the population may be a more relevant cause of this phenomenon than the pure deterioration of health systems. In fact, says Dolores Jiménez, from the Department of Applied Economics at the University of Granada, "the most likely outcome is that the effects of the crisis on the health of citizens will be seen more in the short and medium term."
Perception of users. All these factors are reflected almost automatically in the opinion that users have of the public health system. The Health Barometer prepared by the Center for Sociological Research (CIS) for the Ministry of Health shows how the percentage of those who think that the system works well or fairly well increased until 2010 (73.9% of responses), went down to 62, 7% in 2014 and in 2017 it was 67.6%.
Respondents who think the system works well or fairly well
Reported health However, it seems that the crisis has not directly affected the opinion that citizens have about their health. In 2010 72.1% believed that this was good or very good. In 2017 they were 74%. The president of health economists adds that, in times of economic crisis, it often happens that people put other issues (unemployment, housing) before themselves, and, therefore, give less importance to other issues.
HOSPITAL REVENUES FOR MENTAL HEALTH
Private sanity. One issue that has been touched by the health system is prestige, which can be measured in some way by the progress of private healthcare. Of the total health expenditure of the country, the Administrations took charge of 73.6% in 2008; in 2017, they did it at 70.8%. Or what is the same: the private advanced three points in 10 years. A symptom in this sense is that they have been two health companies that have announced that they will install two teams of proton emission (a more precise type of radiotherapy, especially indicated for childhood and brain tumors). Currently some 8.2 million people have private insurance in Spain, plus three million employees through Muface.
Mental health is the one that more accuses the cuts in Health, according to the study Economic Crisis and Health which ended at the end of 2018 a team led by Juan Oliva, of the University of Castilla-La Mancha, for the Ministry of Health. The work shows that this deterioration occurs more in men than in women.
The hospital morbidity survey of the Ministry of Health shows that, in general, during the years of the crisis, people who were admitted to hospitals increased. Apart from the aging factor, there are others such as the waiting list or the possible effects of co-payment or primary saturation that may explain this situation. Both the hospitalizations due to mental health problems and the total ones fell between 2008 and 2012, and then began to rise.
But, in addition, in the case of income from psychiatric disorders, in addition to varying the amount of income changed the duration of the same, which can be considered an indicator of its severity. And it also went down until 2012 to go up later.